Abstract | BACKGROUND AND AIMS: PATIENTS/METHODS: A total of 305 consecutive patients who had undergone total thyroidectomy for papillary thyroid carcinoma were divided into three groups: group A (n = 64) showed evidence of node metastases and received therapeutic bilateral central node dissection; group B (n = 93) showed negative nodes and received prophylactic ipsilateral central node dissection; group C (n = 148) showed negative nodes and received total thyroidectomy alone. The rates of transient and permanent complications within the three groups were compared. RESULTS: Histopathological examination detected node metastases in 46 (72%) group A patients and in 20 (21%) group B patients. Parathyroid autotransplantation was carried out in 41 (64%) patients in group A, 55 (59%) in group B, and 43 (29%) in group C (P < 0.001). One or more parathyroid glands were found in 20% of the specimens from group A, 11% of those from group B, and 9% of those from group C. None of the patients in either group A or group B reported permanent laryngeal recurrent nerve paralysis, but two (1.3%) in group C did. Transient laryngeal recurrent nerve paralysis occurred most often in group A patients (7.8% versus 5.4% versus 1.3%, respectively) and was bilateral in two patients (one in group A and one in group B). None of the patients in either group A or group B developed permanent hypoparathyroidism, but four (2.7%) in group C did. Transient hypoparathyroidism was highest in group A patients (31% versus 27% versus 13%, respectively; P = 0.003). Postoperative bleeding requiring reoperation occurred in one group B patient and in two group C patients. CONCLUSIONS: Central neck dissection did not increase permanent morbidity and revealed a significant rate of nonclinically evident node metastases. In experienced hands, central neck dissection should be routinely combined with total thyroidectomy in the primary treatment of pre- or intraoperatively diagnosed papillary thyroid cancer. When no macroscopic evidence of metastasis is present, ipsilateral central neck dissection is the best treatment strategy in a balanced decision between the need for achieving local radical excision, correct disease staging, and reducing the risk of complications.
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Authors | N Palestini, A Borasi, L Cestino, M Freddi, C Odasso, A Robecchi |
Journal | Langenbeck's archives of surgery
(Langenbecks Arch Surg)
Vol. 393
Issue 5
Pg. 693-8
(Sep 2008)
ISSN: 1435-2451 [Electronic] Germany |
PMID | 18592264
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary
(pathology, surgery)
- Child
- Combined Modality Therapy
- Female
- Humans
- Hyperparathyroidism, Primary
(pathology, surgery)
- Lymph Nodes
(pathology)
- Lymphatic Metastasis
(pathology)
- Male
- Middle Aged
- Neck Dissection
(methods)
- Neoplasm Staging
- Parathyroidectomy
- Postoperative Complications
(etiology)
- Thyroid Gland
(pathology)
- Thyroid Neoplasms
(pathology, surgery)
- Thyroidectomy
(methods)
- Vocal Cord Paralysis
(etiology)
- Young Adult
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